Physical Training Induced Plasticity of Motor Control Mechanisms in Parkinson's Disease Patients
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 60
- 主要终点
- Force measurements of bimanual dexterity function
研究概览
简要总结
There are experimental evidences of the important role of exercise in the PD, that induces similar effects to pharmacotherapy. So far, the mechanisms of the impact of these changes on the brain subcortical and cortical regions functioning, motor activities and cognitive functions are still not clear. The aim of this longitudinal human experiment is to examine the effects of cycle of 8-week high-intensity interval training (HIIT) on: (i) neurophysiological function of cortical motor structures and skeletal muscle actvity, (ii) psychomotor behavior critically associated with dopamine dependent neural structures functioning and (iii) neurotrophic factors' secretion level in blood. The investigators will recruit 40 PD individuals, who will be divided into two groups: one of them will perform two 8-weeks cycle of HIIT (PD-TR), and the other will not (PD-NTR). The investigators will recruit also 20 age-matched healthy controls (H-CO) as additional control group who will not perform the HIIT. All PD subjects will be examined during their medication "OFF-phase" pre HIIT and 1 week-, 1 month-POST cycle of HIIT. The subject from H-CO will be tested only once. To examine the assumed HIIT-induced changes in brain functioning the investigators will use: (i) EEG (recorded simultaneously with EMG) methods to assess an amplitude, location and directionality of brain electrical current of cortical regions and strength of intra-cortical network interactions during motor tasks performance. During the EEG experiments the subjects will perform (i) bimanual anti-phase DA level dependent motor tasks (during which the investigators will record EMG, force). The investigators will also assess motor and non-motor symptoms of PD and functional test of manual dexterity to evaluate a quality psychomotor behavior.
Using these methods the investigators will determine in detail the mechanisms of functioning of the CNS in PD patients, with emphasis on the cortical interactions that are dependent on synthesis and DA transmission. The results of the study will help to answer the fundamental questions about HIIT induced neuroplasticity in PD patients, as well as complement the lack in knowledge about the mechanisms of exercise-induced changes in PD, and as a consequence it could enrich the golden standard of treatment in PD from pharmacotherapy toward implementation of precise evidence based rehabilitation.
详细描述
I. Research Project Objectives
Aim 1. To characterize an influence of 8-week HIIT cycle on neurophysiological functions (NPFs) of: (i) motor cortical structures, (that are critically dependant on the presynaptic DA availability), using EEG, and (ii) skeletal muscles engaged in motor task, using surface EMG. The following neurophysiological functions of CNS will be tested during performance of the DA availability-dependant self initiated bimanual motor tasks: (i) a level of activation of cortical structures, and (ii) strength of functional coupling between neural structures. For skeletal muscles NPFs', the investigators will study a strategy of motor units activation. Also, since the investigators will record EEG and EMG simultaneously, the investigators will assess strength of cortico-muscular coupling.
Hypothesis 1. NPFs will improve after the 8-week HIIT cycle compared to baseline in the PD-TR group, and will sustain one month post HIIT. Namely, the investigators speculate that for the motor in CNS activity, it will be: (1) primary motor cortex (M1), supplementary motor area (SMA); (2) decrease of activation of lateral premotor cortex (PMC) and cerebellum; with simultaneous (3) increase of functional coupling of: dorsolateral prefrontal cortex (DLPFC) with M1, PMC, SMA and cerebellum; (4) decrease of functional coupling between M1, PMC, SMA, cerebellum and parietal cortex. For the skeletal muscle function it will be an improvement in recruitment strategy of motor units. Taking into the data from the simultaneous recording of electrical activity of brain cortex and skeletal muscles engaged in motor tasks, the investigators assume strengthening of corticomuscular coupling. In the PD-NTR group NPFs will not improve or even will be worsened in the same time interval.
Aim 2. To characterize an influence of the 8-week HIIT cycle on the psychomotor behaviors (PMBs), critically dependant on the DA availability and brain's NPFs. The following PMBs will be tested during several experiments: (1) self initiated bimanual anti-phase movement tasks during the simultaneous EEG, EMG and force recordings (2) all motor and non-motor PD symptoms evaluation, based on neurological assessment, (3) overall cognitive function and specifically aspects of executive function using psychological tests.
Hypothesis 2. PMBs will improve after the 8-week HIIT cycle compared to baseline in the PD-TR group, and will sustain one month post HIIT, as a consequence of the improvements of presynaptic striatal DA availability and NPFs, The PMBs improvement will not be present in the PD-NTR group, or even the PMBs will be worsened in the same time interval.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 55 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •for PD patients: age 55-75 years-old; diagnosis of idiopathic PD; and modified Hoehn and Yahr stages between 1.5 and 3
- •for healthy controls: lack of neurological disorders
排除标准
- •for PD patients: (i) presence of other neurological disorders, (2) any cardiovascular and respiratory system restrictions and/or motor deficits that could limit performance in high-speed pedaling on a cycle ergometer or in the conventional physical therapy and (3) practicing any regular physical activity except for physical therapy for PD
- •for healthy controls: presence of neurological disorders
研究组 & 干预措施
PD-TR
Intervention:
exercise, dose: 8-week HIIT program (three times a week) & conventional physical therapy
干预措施: exercise (Behavioral)
PD-TR
Intervention:
exercise, dose: 8-week HIIT program (three times a week) & conventional physical therapy
干预措施: conventional physical therapy (Behavioral)
PD-NTR
conventional physical therapy
干预措施: conventional physical therapy (Behavioral)
Healthy controls
healthy controls without any kind of therapy
结局指标
主要结局
Force measurements of bimanual dexterity function
时间窗: 1-month-post HIIT cycle
force development measurements of self initiated bimanual anti-phase hand grip-load function, using force transducers system. The force will be expressed in \[N\], the time of force development in \[s\] and the rate of force development in \[N/s\].
ST-I - Stroop Test, part I
时间窗: 1-month-post HIIT cycle
ST-I is used as a psychological measure of processing speed, measured as performance time (the shorter the time the better performance), expressed in \[s\].
NGF - nerve growth factor
时间窗: 1-month-post HIIT cycle
NGF secretion level in blood expressed in \[pg/mL\]
IGF 1 - insulin-like growth factor 1
时间窗: 1-month-post HIIT cycle
IGF 1 secretion level in blood expressed in \[pg/mL\]
Force measurements of both hands' index fingers motor control
时间窗: 1-month-post HIIT cycle
force development measurements of self initiated bimanual anti-phase index finger movements, using force transducers system. The force will be expressed in \[N\], the time of force development in \[s\] and the rate of force development in \[N/s\].
Electroencephalography (EEG) - electrical activity of brain cortex recorded from scalp using surface electrodes.
时间窗: 1-month-post HIIT cycle
To evaluate neurophysiological functions of brain cortical structures, electroencephalography (EEG - electrical activity of brain cortex) will be recorded from scalp using 64-chanel system. The recordings will be conducted during bimanual motor tasks and at rest. The recordings will be expressed in microvolts \[µV\].
Electromyography (EMG) - recordings of electrical activity of skeletal muscles using surface electrodes.
时间窗: 1-month-post HIIT cycle
To evaluate neurophysiological functions of muscles engaged in an activity (hand and forearm muscles), electromyography (EMG - recordings of electrical activity of skeletal muscles) will be collected using surface electrodes, during bimanual motor tasks and at rest. The recordings will be expressed in milivolts \[mV\].
BDNF - brain derived neurotrophic factor
时间窗: 1-month-post HIIT cycle
BDNF secretion level in blood expressed in \[pg/mL\]
TMT-A - trail making test, part A
时间窗: 1-month-post HIIT cycle
TMT-A is a psychological measure of cognitive processing speed, measured as performance time (the shorter the time the better performance), expressed in \[s\].
TMT-B - trail making test, part B
时间窗: 1-month-post HIIT cycle
TMT-B is a psychological measure of executive function, measured as performance time (the shorter the time the better performance), expressed in \[s\].
ST-II - Stroop Test, part II
时间窗: 1-month-post HIIT cycle
ST-II is used as a psychological measure of selective attention and inhibition, measured as performance time (the shorter the time the better performance), expressed in \[s\].
次要结局
- UPDRS - unified Parkinson's disease rating scale(1-month-post HIIT cycle)
- MMSE - Mini Mental State Examination(Baseline)
- H&Y scale - Hoehn and Yahr scale(1-month-post HIIT cycle)
- S&E DLA scale - Schwab and England Daily Living Activity Scale(1-month-post HIIT cycle)
研究者
Jaroslaw Marusiak
Principal Investigator
Wroclaw University of Health and Sport Sciences